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Doctors with addictions: double standards?

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Doctors with addictionsDoctors get addicted to alcohol and other drugs; there’s plenty of evidence of that. My question is: Do doctors with addictions get the same kind of treatment and outcomes as their patients?  The British Medical Association estimates that there are 10,000 to 13,000 addicted doctors in the UK. Most of them will be in practice.

What is the expectation for doctors coming to treatment in the UK? Well, the goal of abstinence is pretty much accepted as a given (even for IV opiate addicts) and their access to quality treatment of adequate duration is greater. Outcome studies from the USA consistently show recovery rates of 80% and there is evidence from the Practitioner Health Programme (PHP) in London this is also true in the UK. Most doctors in recovery return successfully to work.

Survey of doctors with addictions

A tiny survey of Scottish doctors in recovery was recently published in the Medical Council on Alcohol bulletin. The questionnaire was sent to about 60 doctors with only 17 responded (12 men and 5 women). Caution is needed in interpretation as the numbers won’t mean too much. Nevertheless it’s interesting to look at what was found. Most (70%) were in recovery from alcohol dependence with 18% acknowledging mixed drug and alcohol problems and the rest purely drugs. Most of the doctors’ employers were aware of their diagnosis. Only 4 out of the 17 hadn’t had some sort of restriction imposed on them by the GMC and almost all had had to take time off work as a result of their addiction and treatment.

These doctors were all members of the British Doctors and Dentists Group, a mutual aid organisation with 17 meetings across the UK. The survey didn’t ask about the part mutual aid played in their recoveries, but given the nature of the sampling method, we can speculate that mutual aid played some part. In studies from across the Atlantic profession-specific and generic mutual aid are usually reported as positive factors. Another issue that is likely to be relevant in the high recovery rates of doctors is post-treatment monitoring. Doctors under GMC supervision will have regular blood, urine and hair testing, done over years, to evidence enduring abstinence.

We have more robust data from England to add to the evidence. In the PHP in London, of the 160 addicted medics treated in 3 years of the service operating, 79% ended up in abstinent recovery compared to “10-20% of those treated in the general population.’

Why do doctors with addictions do so much better than their patients? From the evidence we have on the issue, it looks as if the aspiration for doctors, as far as recovery goes, is high. It also seems from the PHP data that substitute prescribing for opiate addicted doctors is the exception rather than the rule. Pathways to residential treatment seem to be more available and there does seem to be a practice of assertive referral to mutual aid groups like the British Doctors and Dentists Group and 12-step groups. Finally monitoring is comprehensive and fairly enduring. Doctors arguably have high recovery capital and a lot to lose if they don’t recover, but I still think they get a better deal than their patients.

I wonder why we accept a different type of management and better outcomes for doctors. Don’t their patients deserve these kind of results too? Researchers have argued that physician’s health programmes should set the standard for recovery, and I am with them. Shouldn’t we be challenging double standards and raising the bar for all clients in treatment services?

    4 Responses to "Doctors with addictions: double standards?"
    1. I agree completely. The standard needs to be abstinence, and the treatment needs to be comprehensive and long-term. All recovery models should be based on what works, not on what’s convenient.

      • djmac says:

        I think the bar does need to be set high and treatment of adequate duration and intensity. That’s what happens in other difficult-to-treat conditions. The problem of knowing what works is that the evidence base for recovery is so under researched. However, there is enough evidence to inform us of what elements service providers should have at the core of their service.

    2. Mark Gilman says:

      The North West Through The Gate Substance Misuse programme is designed to deliver the PHP to addicted prisoners. Watch this space

      • djmac says:

        Hey Mark, what kind of a tease is that? Tell us more about it! I am hoping to review the RAPT paper on outcomes in prison populations soon for Recovery Review.

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